Ophthalmology and Optometry Coding Alert

Question: Can I bill an entropion repair (67924) and a canthoplasty (67950) together, or does Medicare consider them to be bundled procedures?

South Carolina Subscriber

Answer: You can report 67924 and 67950 together under certain circumstances. You need to be aware of the differences between the two codes, though. Entropion eyelid repair codes are used to represent the procedure that corrects a problem when the eyelid is pulled so much that the eyelashes are exposed. The procedure often exposes the inner part of the eye. Entropion refers to the inward turning of the upper or lower lid.

On the other hand, canthoplasty is often referred to as corner eye lift or eye tendon surgery. The ophthalmologist uses this technique to strengthen the lateral canthal tendon or orbicularis muscle at the outer corner of the eyelids, sometimes to prevent ectropion problems.

The National Correct Coding Initiative 8.1 bundled 67950 in with the eyelid reconstruction codes 67971 and 67975. However, NCCI assigns these bundles a "1" indicator, which means you can unbundle these codes with modifier -59 (Distinct procedural service) under certain circumstances. Modifier -59 identifies procedures/services that are not normally reported together but may be performed under certain circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician.